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by Savitsky D

Pill Splitting Can Save Money, But Talk to Your Doctor First

IMAGE It may feel like the cost of your prescription goes up every time you refill it. For those who pay for prescriptions out-of-pocket or have capped prescription coverage, the rising cost of necessary medication can be troubling.
However, people who take some of the most commonly prescribed drugs may be able to reduce costs. A study in the American Journal of Managed Care explored the practice of pill splitting. Pill splitting saves money because the per-pill price usually does not vary significantly according to dosage. This is how it works: your doctor writes a prescription for a dosage level twice that of what you need. Then you split the pills in half and you end up with twice as many pills for the same price. But be wary. Pill splitting may not be a good choice even if it means saving money. The US Food & Drug Administration (FDA) advises against pill splitting, unless the drug label states that it is okay. Some concerns over pill splitting include:
  • Forgetting to split a tablet or being confused by the correct dose, which can lead to accidental overdose
  • Not splitting the pill evenly
  • Pills with unusual shapes or sizes may be difficult to split
Here are other concerns you should be aware of regarding pill splitting.

Splitting—Not Safe for All Drugs

In a study in the American Journal of Managed Care, researchers studied if pill splitting can reduce the cost of drugs without compromising their safety and effectiveness. They also set out to identify the drugs that are most appropriate for splitting. These researchers examined the pharmacy records of a managed care plan at Massachusetts General Hospital in Boston.
The study identified the 265 drugs most frequently prescribed at the study hospital and nationally. About half of the drugs cannot be split. These include drugs with the following characteristics:
  • Manufactured as capsules
  • Available in only one dose
  • Not taken by mouth (like an inhaler)
  • Prepackaged pills, such as birth control pills
  • Cannot easily be broken
  • Have an enteric coating, allowing the medication to remain whole until it passes through the stomach to the intestine
  • Extended-release

Talk to Your Doctor Before You Split Pills

Do not split pills without first discussing the safety of the practice for each of your medications with your doctor. For some patients, pill splitting is unwise, resulting in uneven dosing and ineffective treatment. People who have the following issues may want to avoid pill splitting:
  • Cognitive impairment
  • Debilitating arthritis
  • Poor dexterity or eyesight
  • Recurring tremors
If you are going to split pills regularly, invest in a pill-splitting device. They are easy to use and allow you to split pills quite accurately. Your pharmacist can show you how to use it.
The FDA does not recommend splitting the entire supply of pills at once. Only split one at a time.
Also, if you switch from one brand of medication to another, you need to make sure that it is still safe to split the pills. Make sure to check the package to make sure that the pill is FDA approved to be split.
If you and your doctor decide that pill splitting is a good strategy for you, you may be able to save a good portion of the money you are now spending on medication.

RESOURCES

Family Doctor—American Academy of Family Physicians
https://familydoctor.org
US Food & Drug Administration
https://www.fda.gov

CANADIAN RESOURCES

Canada Safety Council
http://canadasafetycouncil.org
Health Canada
http://www.phac-aspc.gc.ca

References

Best practices for tablet splitting. US Food & Drug Administration website. Available at: https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/ucm184666.htm. Updated August 23, 2013. Accessed March 13, 2017.
Choe HM, Stevenson JG, Streetman DS, Heisler M, Sandiford CJ, Piette JD. Impact of patient financial incentives on participation and outcomes in a statin pill-splitting program. Am J Manag Care. 2007;13(6 Part 1):298-304.
Cohen CI, Cohen SI. Potential cost savings from pill-splitting of newer psychotropic medications. Psychiatr Serv. 2000 Apr;51(4):527-9.
Cross M. Two for the price of one beauty of pill-splitting catches on. Manag Care. 2003;12(2):36-38.
Miller DP, Furberg CD, Small RH, Millman FM, Ambrosius WT, Harshbarger JS, Ohl CA. Controlling prescription drug expenditures: a report of success. Am J Manag Care. 2007;13(8):473-480.
Stafford RS, Radley DC. The potential of pill splitting to achieve cost savings. Am J Managed Care. 2002;8(8):707-712.
Tablet splitting: a risky practice. US Food & Drug Administration website. Available at: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm171492.htm. Updated July 25, 2015. Accessed March 13, 2017.

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